Falls in Functional Neurological Disorder: Prevalence, Risk Factors and Clinical Implications

Functional neurological disorder (FND) is a disabling condition often presenting with motor impairments, including gait disturbance and postural instability. Data on the prevalence and predictors of falls in people with FND are limited. This study aimed to investigate the prevalence of self-reported falls among individuals with motor FND and identify factors associated with falling.

Adults with motor FND were recruited from a tertiary neurology centre in London, UK, December 2021 to August 2024. Participants reported falls within the previous 6 months and completed assessments of sensory impairment, mobility, pain, fatigue, depression and anxiety. Group differences between recurrent fallers (≥ 2 falls) and those with one or no falls were examined, and logistic regression analyses identified predictors of recurrent falls.

One hundred participants (81% female, mean age 43.7 ± 14.2 years) were included. Falls were reported by 62%, and 56% reported recurrent falls. Among fallers, 64% reported injuries including bruising (39%), laceration (8%) and fracture (6%). Recurrent fallers had poorer plantar sensation and vibration detection, as well as worse scores for anxiety, depression, pain and functional mobility. A multivariable regression model indicated that absent plantar sensation (OR = 5.30, 95% CI [1.37, 20.44], p = 0.015), greater pain severity (OR = 1.25, 95% CI [1.05, 1.48], p = 0.011) and greater anxiety (OR = 1.09, 95% CI [1.004, 1.18], p = 0.040) were associated with increased odds of recurrent falls.

Falls are common among individuals with motor FND. Absent plantar sensation, pain and anxiety were independently associated with recurrent falls, supporting a multidimensional approach to falls assessment and rehabilitation.